The effects of sociodemographic factors on help-seeking for depression: Based on the 2017–2020 Korean Community Health Survey

When individuals face psychological difficulties that exceed their resources, consulting professionals for mental health treatment can be an effective way to overcome these difficulties. However, in general, only a few patients receive treatment for depression. The goal of the present study was to explore the help-seeking behaviors of currently employed individuals with depression and the factors influencing their help-seeking behaviors. This study used raw data from the Korean Community Health Survey (KCHS) obtained from 2017 to 2020. A total of 6,505 employed individuals, who responded as having experiences of sadness or hopelessness that caused problems in their lives for more than two weeks and who scored more than nine points on the Patient Health Questionnaire-9, were included in our analysis. Help-seeking behavior was measured as receiving expert advice due to feelings of sadness or hopelessness. Of the 6,505 people with depression, only 1,781 (27.38%) received professional counseling for it. Male participants (adjusted odds ratio [aOR] = 1.31, 95% confidence interval [CI] = 1.157–1.487), those aged 45–64 years (aOR = 1.192, 95% CI = 1.022–1.389) and more than 75 years (aOR = 1.446, 95% CI = 1.059–1.973), those not having a Medical Aid program (aOR = 1.750, 95% CI = 1.375–2.226), and those having low educational levels (aOR = .896, 95% CI = .830–.968) were less likely to seek professional help for depression. Our study found that help-seeking behaviors for depression in the Korean population were low. Furthermore, we identified the characteristics associated with individuals with depressive symptoms who chose not to receive help from mental health professionals. The results of this study provide insights to guide national interventions to increase help-seeking behaviors for depression.

7 Especially, depression in the productive population causes more social burden → no citation? This seems necessary to me for such a statement 84 8 Concerning Stigma: Too short paragraph with little reflection of different types of stigmatising attitudes and how they might impact the help-seeking process of people with depressive symptoms. I suggest that the authors reflect a little more on stigma. Such as "internalised", "anticipated" and "help-seeking" sigma are possible search word I suggest looking up in this context. Also, why is it discussed in the theory if it was not measured and therefore not included in the results? 75-79 9 using the standardized method of the Korean Community Health Survey → confusing sentence, since the Survey is not a standardised method…? Is it a survey that is repeatedly issued ever so often? Clarify please.

88
10 Patients with unemployment were excluded from the study.
→ Why? These are an especially vulnerable group (also for depression) and concerning stigma/help-seeking and financial barriers you wrote about above, they seem to be of special interest? Please clarify the rational.
➔ Although I appreciate the changes made, I still find the exclusion to be problematic. It would, in my opinion, be more prudent to keep people with no current employment in the sample and categorise them as the 5. category in "occupation". In the way the rational is presented here, there is an implicit discrimination in the study against people with no current employment. You argue "Since various sociodemographic factors are related to help-seeking behavior and depression, it is difficult to generalize results of research to all population groups in the community"(ll. 84-86) and then exclude a part of the population to analyse the "productive population", making the findings in this study less generalizable.

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11 Measures chapter should be revised extensively! Rational is missing for: • Why were ages grouped like this?
• Why was income grouped like this (is it usually done like this in other articles)? • Why was occupation grouped like this? -also why not unemployment (still wondering about this).
➔ All in all this is a lot better! However, reliability scores are still missing for PHQ-9 and subjective stress (why?) 12 Nine points on the Patient Health Questionnaire-9 (PHQ-9).
Why 9? It is just stated that you reviewed the literature, yet no argument is given. 15 Statistical Analysis chapter is also lacking in information.
Which test were used exactly? Was checked for test prerequisites? I suggest building the sentences as follows: To analyse if … we conducted … tests after checking for … prerequisites (or in a similar manner).
Remember. I have to understand exactly what you did and why so that (especially since you allow for data sharing) I could replicate your findings exactly after having read your article.

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16 Principal component analysis with direct oblimin rotation (δ=0) was used to extract the main factors with eigenvalues >1.0. → This is a good example for information that sadly doesn't tell me why you did this?
Sometimes you do this, sometimes not? Ex., this is annoying to read: Of the 561,654 people, 16,390 received more than nine points on the PHQ-9, 25,790 felt sad or hopeless ➔ The changes are helpful, but why not use . instead of , to write big numbers?

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18 Table 1 is a good overview. However, please format (e.g., capital letters someplace, other places small letter) and you must ad a "note" under the table to explain it. Tests used, "*"-meanings etc. (refer to reporting standards). Tables should be able to "stand by themselves" with no further information needed from the text (which is lacking due to the brief measures section anyhow). 20 Table 2 title is missing -please amend. The "note" information is lacking. See comment 18. Also, the note that is written is confusing, because no major loadings are shown in "bold face"?
➔ Table 2 title is still missing. These superficial things should be done with care! Please amend.  059-1.973). → Possibly it is also a language issue: "more likely not to seek hep" = "less likely to seek help" ➔ Generally in multiple regressions, it is more usual to report the findings in reference to the reference group. I didn't notice this before due to the double negative, but for example I suggest writing the results as follows: "It was found X were more likely to seek help for depression than Y" (and Y is the reference group) ➔ Also, there is a confusing presentation of the multiple regression results that need to be simplified. You code "help-seeking" as 0 and "non-help seeking" as 1. That would mean that those groups with aOR>1 were more likely not to seek help compared to the reference group and this leads to confusing double negatives in the results section: e.g.: "Individuals who did not have Medical Aid program were less likely to seek help for depression than individuals with Medical Aid program" (l. 205). It would be a lot easier for the reader if a) the help-seeking outcome were coded as 0=no help and 1=help seeking and the results section written with simple "X was more likely then Y to seek help" or "X was less likely then Y to seek help" (Y being the reference category). ➔ I could only find the categorisation as 0=help seeking and 1=no help-seeking in the note of table 3, which I first didn't read and then was confused to the result interpretation. It should also be transparently written so in the paragraph "statistical analysis".
Ex.: 177-180 22 Table 3 better than 1 an 2. However, why are some aOR bold faced and others are not? The heading should also be more descriptive so that the reader knows straight away what they are looking at.